As the global population confronts the coronavirus crisis with a shutdown unseen in living memory, we are being reminded of some basic truths:
THREATS:
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- Initial outbreak in Wuhan – 1300 health workers infected
- Rate of infection is 3 times higher than general population
- 42,000 health workers were brought in from other provinces
- Patient carers should not become patients.
- Cannot lose health workers in 14 days self quarantine
MEASURES:
- Methods adopted later in Wuhan resulted in ZERO infection of new health care workers
- Health care workers housed away from their families
- Full-body protective gear, including goggles, complete head coverings, N95 particle-filtering masks, and hazmat-style suits (hazardous materials suit)
- Testing ramped up aggressively
- Regular surgical masks for all patient interactions
- Use gloves and proper hand hygiene
- Disinfect all surfaces in between patient consultations.
- Patients with suspicious symptoms (a low-grade fever coupled with a cough, respiratory complaints, fatigue, or muscle aches) or exposures (travel to places with viral spread or contact with someone who tested positive) be:
separated from the rest of the patient population, and treated
- wherever possible—in separate respiratory wards and clinics
- separate locations, with separate teams.
- Social distancing practiced within clinics and hospitals:
- waiting-room chairs placed six feet apart
- direct interactions among staff members are conducted at a distance
- doctors and patients stay six feet apart except during examinations
- All workers report any fever or flu symptoms prior to starting work each day
THINGS TO AVOID:
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- Full protection NOT for every worker – N95 masks, face-protectors, goggles, and gowns reserved for procedures where respiratory secretions can be aerosolized (for example, intubating a patient for anesthesia) and for known or suspected cases of COVID19.
- When someone unexpectedly tests positive—say, a hospital co-worker or a patient in a primary-care office or an emergency room? Do not shut the place down or put everyone under home quarantine. Trace every contact and then quarantine only those who had close contact with the infected person. In Hong Kong, “close contact” means 15 minutes at a distance of less than six feet and without the use of a surgical mask. In Singapore, 30 minutes.
- If the exposure is shorter than the prescribed limit but within six feet for more than two minutes, workers can stay on the job if they wear a surgical mask and have twice-daily temperature checks.
- People who have had brief, incidental contact are just asked to monitor themselves for symptoms.
CAUTION:
Closing borders to prevent epidemics often draws attention away from measures that would do more good
MORE LESSONS
Though it appears to be more contagious than the flu, covid-19 can still be managed by the standard public-health SOP: social distancing, basic hand hygiene and cleaning, targeted isolation and quarantine of the ill and those with high-risk exposure, an increase in health-care capacity (supplies, testing, personnel, wards), and coordinated, unified public communications with clear, transparent, up-to-date guidelines and data.
Transmission seems to occur primarily through sustained exposure in the absence of basic protection or through the lack of hand hygiene after contact with secretions.
Singapore so far has no recorded health-care-related transmission, despite hundreds of cases. That includes one case of a critically ill pneumonia patient who exposed 41 health-care workers in the course of four days before being diagnosed with covid-19. These were high-risk exposures, including exposures during intubation and hands-on intensive care. 85% of the workers used only surgical masks. Yet, owing to proper hand hygiene, none became infected.
(Compiled by P.B.O Warjri, retired Chief Secretary of Meghalaya)